Provider Demographics
NPI:1679146344
Name:MANTHEY, SAMANTHA ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ANN
Last Name:MANTHEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21766 XENON ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-8426
Mailing Address - Country:US
Mailing Address - Phone:612-708-3626
Mailing Address - Fax:
Practice Address - Street 1:7876 SUNWOOD DR NW STE 200
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:MN
Practice Address - Zip Code:55303-5178
Practice Address - Country:US
Practice Address - Phone:763-283-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist